Bhatia Vikram, Singhal Amit, Panda Subrat Kumar, Acharya Subrat Kumar
Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Hepatology. 2008 Nov;48(5):1577-85. doi: 10.1002/hep.22493.
Pregnant patients with acute liver failure (ALF) are believed to have a worse outcome than nonpregnant women and men with ALF. However objective data supporting this supposition are scant. Therefore, the current study compared the outcome, complications, and causes of ALF among pregnant women and girls with age-matched nonpregnant women and girls and men and boys with ALF. One thousand fifteen consecutive ALF patients in the reproductive age group, admitted at the All India Institute of Medical Sciences, New Delhi, from January 1986 to December 2006, were included in the study. A total of 249 (38.5%) women were pregnant. They were compared with 341 nonpregnant women and girls and 425 men and boys, aged 15 to 45 years. The mortality rate of pregnant women and girls (53.8%) was similar to age-matched nonpregnant women and girls (57.2%), and men and boys (57.9%); P = 0.572. The clinical and biochemical features, disease severity, and complications were also similar in the three groups. A significantly higher proportion of ALF was attributable to hepatitis E virus (HEV) among women and girls who were pregnant (59.4%), as compared with both nonpregnant women and girls (30.4%), and men and boys (23.1%); P < 0.001. However, the outcome of HEV-related ALF was independent of the sex and pregnancy status of the patients (P = 0.103). Mortality in HEV-ALF and non-HEV-ALF patients in pregnant women and girls was 51% (74/145) and 54.7% (52/95)(P > 0.1), respectively. The outcome of pregnant ALF patients was also unrelated to the trimester of pregnancy. The mortality of non-HEV-related ALF among the pregnant women and girls (54.7%), age-matched nonpregnant women and girls (61.7%), and men and boys (62.8%) were also similar (P > 0.1).
The mortality of pregnant patients with ALF is similar to that of nonpregnant women and girls and men and boys and is independent of the cause or trimester. Pregnancy per se should not be regarded as a poor prognostic factor for a patient with ALF.
人们认为，患有急性肝衰竭（ALF）的孕妇比患有ALF的非孕妇及男性预后更差。然而，支持这一假设的客观数据却很少。因此，本研究比较了患有ALF的孕妇和女童与年龄匹配的非孕妇和女童以及患有ALF的男性和男童的预后、并发症及病因。本研究纳入了1986年1月至2006年12月在新德里全印度医学科学研究所收治的1015例连续的生殖年龄组ALF患者。共有249例（38.5%）女性为孕妇。将她们与341例年龄在15至45岁的非孕妇和女童以及425例男性和男童进行比较。孕妇和女童的死亡率（53.8%）与年龄匹配的非孕妇和女童（57.2%）以及男性和男童（57.9%）相似；P = 0.572。三组的临床和生化特征、疾病严重程度及并发症也相似。与非孕妇和女童（30.4%）以及男性和男童（23.1%）相比，孕妇和女童中由戊型肝炎病毒（HEV）导致的ALF比例显著更高（59.4%）；P < 0.001。然而，HEV相关ALF的预后与患者的性别及妊娠状态无关（P = 0.103）。孕妇和女童中HEV - ALF患者及非HEV - ALF患者的死亡率分别为51%（74/145）和54.7%（52/95）（P > 0.1）。孕妇ALF患者的预后也与妊娠 trimester无关。孕妇和女童中与非HEV相关的ALF死亡率（54.7%）、年龄匹配的非孕妇和女童（61.7%）以及男性和男童（62.8%）也相似（P > 0.1）。
患有ALF的孕妇的死亡率与非孕妇和女童以及男性和男童相似，且与病因或妊娠 trimester无关。妊娠本身不应被视为ALF患者预后不良的因素。 （注：原文中“trimester”未明确具体所指，翻译时保留英文）
